Saturday, 14 November 2009

Better late than never: WHO correction

Earlier one group of WHO experts only recommend Tamilflu after 3 daysby which time the effectiveness of Tamilflu is proven to be almostzero based on manufacturers' tests.

It has caused more deaths than those who don't get any Tamilflu atall, and most probably responsible for the increase in the number ofTamilflu resistant swine flu.

Soon all the expensive Tamilflu stocks will be useless as a result ofthat stupid WHO recommendation when the number of Tamilflu resistantcases overwhelm the normal swine flu.

You may argue that WHO never recommend the administration of Tamilfluafter 48 hours but giving a directive that ONLY THOSE WITH PROVENSERIOUS CASES BE GIVEN TAMILFLU is the same as saying that, becauseserious cases can only be proven more than 48 hours of flu symptoms.

With the introduction of vaccination, it is now time to finish all theTamilflu stocks in order to save as many lives as possible.

Despite all the meaningless deaths caused by the earlier WHOrecommendation, stupidly implemented by thoughtless doctors, this newrecommendation should be welcomed.

It does not mean the most doctors are thoughtless. In fact most ofthem have ignored this earlier directive as shown by various medicaladvises given by successful doctors who managed to save lives.

At the same time, it says it is sending emergency supplies ofantivirals -- such as Tamiflu and Relenza -- to developing countrieshardest hit by the pandemic, including Afghanistan, Azerbaijan,Belarus, Kyrgyzstan, Ukraine, and Mongolia.

The WHO recommendation to administer antivirals early is a dramaticturnaround from the UN agency's earlier guidelines.

Previously, the WHO had urged doctors to use laboratory tests toconfirm that patients have the H1N1 virus before administeringantiviral drugs.

But the organization said on November 12 that as medical workers havegained experience with swine flu, they have learned that waiting forlab tests can be a fatal delay.

"People in at-risk groups need to be treated with antivirals as soonas possible when they have flu symptoms," Dr. Nikki Shindo, a medicalofficer with the WHO's global influenza program, told reporters inGeneva. "This includes pregnant women, children under 2 years old, andpeople with underlying conditions such as respiratory problems."

She said that people who are not in high-risk groups can wait a littlelonger.

"People who are not from at-risk groups but who have persistent orrapidly worsening symptoms should also be treated with antivirals,"she said. "These symptoms include difficulty breathing and a highfever that last beyond three days."

But Shindo said the vast majority of patients who contract swine fluwill not have symptoms lasting long enough to require antivirals.

"I want to stress that people who are not from the at-risk group andhave only a typical cold need not take antivirals," Shindo said. "Weare not recommending taking antivirals if otherwise healthy people areexperiencing only mild illness, or as a preventive in healthy people."

Rapid Deterioration

The change in the WHO's guidelines comes as doctors in pandemic areasfind that the H1N1 virus can cause a very rapid deterioration ofhealth in some patients, usually on the fifth or sixth day followingthe onset of symptoms.

The deterioration is characterized by primary viral pneumonia, whichdestroys the lung tissue and does not respond to antibiotics. Evenwhen such patients are placed under intensive care in hospitals, itcan be too late to prevent death.

A plane full of antiviral drugs is unloaded in Ukraine earlier thismonth.Shindo said that the UN health agency asked doctors what they couldhave done differently to avoid the fatalities, and that all had said"without exception" that the outcomes would have been different if thepatients had been treated with an antiviral drug earlier.

The hardest-hit countries since the influenza season began in theNorthern Hemisphere are countries with medical systems that even innormal times have to cope with shortages of funding and medicines.Those fragile systems now have been overwhelmed with flu patients andhave limited stocks of antivirals to cope with the pandemic.

Shindo said the WHO is rushing additional supplies of antivirals tosix countries.

"Recently, we sent supplies to Afghanistan, Mongolia, Belarus, andUkraine," she said, "and we will send antivirals to Azerbaijan andKyrgyzstan."

Rapid Distribution

She called on all the countries to rapidly distribute the new suppliesto local areas so that patients who need them do not have to travel tocentral hospitals.

"A further recommendation we make is that countries decentralize thedistribution of antivirals and insure that general practitioners haveaccess to these medicines for their patients. Patients should not needto visit a hospital in order to get antivirals prescribed," Shindosaid.

Since the H1N1 virus was first identified early this year, it hasswept worldwide and is now the dominant form of flu in circulation.

The WHO says that in areas where there is widespread influenza,doctors should assume that patients with flulike symptoms are infectedwith H1N1.

The flu is unlike normal seasonal influenza in that it appears toparticularly affect younger and healthy people. Worldwide, around 40percent of severe cases are now occurring in previously healthychildren and adults under the age of 50.

By contrast, normal seasonal influenza usually targets older people,with 90 percent of deaths occurring in people over 65 years of age.